J
Pedia
(Rio
J).
2018;94(2):123---130
www.jped.com.b
ORIGINAL
ARTICLE
B ea hing
mode
in luence
on
c anio acial
de elopmen
and
head
pos u e夽
Annel
Chambi-Rocha∗,
MaEugenia
Cab e a-Domínguez,
An onia
Domínguez-Reyes
Uni e sidad
de
Se illa,
Facul ad
de
Odon ología,
Se ille,
Spain
Recei ed
6
Janua y
2017;
accep ed
6
Ap il
2017
A ailable
online
14
Augus
2017
KEYWORDS
B ea hing;
C anio acial
de elopmen ;
Head
pos u e;
Child en
Abs ac
Objec i e:
The
incidence
o
abno mal
b ea hing
and
i s
consequences
on
c anio acial
de el-
opmen
is
inc easing,
and
is
no
limi ed
o
child en
wi h
adenoid
aces.
The
objec i e
o
his
s udy
was
o
e alua e
he
cephalome ic
di e ences
in
c anio acial
s uc u es
and
head
pos u e
be ween
nasal
b ea hing
and
o al
b ea hing
child en
and
eenage s
wi h
a
no mal
acial
g ow h
pa e n.
Me hod:
Nine y-eigh
7---16
yea -old
pa ien s
wi h
a
no mal
acial
g ow h
pa e n
we e
clinically
and
adiog aphically
e alua ed.
They
we e
classi ied
as
ei he
nasal
b ea hing
o
o al
b ea hing
pa ien s
acco ding
o
he
p edominan
mode
o
b ea hing
h ough
clinical
and
his o ical
e al-
ua ion,
and
b ea hing
espi a o y
a e
p edomina ion
as
quan i ied
by
an
ai low
senso .
They
we e
di ided
in
wo
age
g oups
(G1:
7---9)
(G2:
10---16)
o
accoun
o
no mal
age- ela ed
acial
g ow h.
Resul s:
O al
b ea hing
child en
(8.0
±
0.7
yea s)
showed
less
nasopha yngeal
c oss-sec ional
dimension
(MPP)
(p
=
0.030),
whe eas
o he
s uc u es
we e
simila
o
hei
nasal
b ea hing
coun e pa s
(7.6
±
0.9
yea s).
Howe e ,
o al
b ea hing
eenage s
(12.3
±
2.0
yea s)
exhibi ed
a
g ea e
pala e
leng h
(ANS-PNS)
(p
=
0.049),
a
highe
e ical
dimension
in
he
lowe
an e-
io
ace
(Xi-ANS-Pm)
(p
=
0.015),
and
a
lowe
posi ion
o
he
hyoid
bone
wi h
espec
o
he
mandibula
plane
(H-MP)
(p
=
0.017)
han
hei
nasal
b ea hing
coun e pa s
(12.5
±
1.9
yea s).
No
s a is ically
signi ican
di e ences
we e
ound
in
head
pos u e.
Conclusion:
E en
in
indi iduals
wi h
a
no mal
acial
g ow h
pa e n,
when
compa ed
wi h
nasal
b ea hing
indi iduals,
o al
b ea hing
child en
p esen
di e ences
in
ai way
dimensions.
Among
adolescen s,
hese
dissimila i ies
include
s uc u es
in
he
acial
de elopmen
and
hyoid
bone
posi ion.
©
2017
Sociedade
B asilei a
de
Pedia ia.
Published
by
Else ie
Edi o a
L da.
This
is
an
open
access
a icle
unde
he
CC
BY-NC-ND
license
(h p://c ea i ecommons.o g/licenses/by-nc-nd/
4.0/).
夽Please
ci e
his
a icle
as:
Chambi-Rocha
A,
Cab e a-Domínguez
ME,
Domínguez-Reyes
A.
B ea hing
mode
in luence
on
c anio acial
de elopmen
and
head
pos u e.
J
Pedia
(Rio
J).
2018;94:123---130.
∗Co esponding
au ho .
E-mails:
[email p o ec ed],
[email p o ec ed]
(A.
Chambi-Rocha).
h ps://doi.o g/10.1016/j.jped.2017.05.007
0021-7557/©
2017
Sociedade
B asilei a
de
Pedia ia.
Published
by
Else ie
Edi o a
L da.
This
is
an
open
access
a icle
unde
he
CC
BY-NC-ND
license
(h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/).
124
Chambi-Rocha
A
e
al.
PALAVRAS-CHAVE
Respi ac¸ão;
Desen ol imen o
c anio acial;
Pos u a
da
cabec¸a;
C ianc¸as
In luência
do
modo
de
espi ac¸ão
sob e
o
desen ol imen o
c anio acial
a
e
pos u a
da
cabec¸a
Resumo
Obje i o:
A
incidência
da
espi ac¸ão
ano mal
e
de
suas
consequências
no
desen ol imen o
c anio acial
aumen a
e
não
é
limi ada
a
c ianc¸as
com
ácies
adenoideanas.
O
obje i o
des e
es udo
oi
a alia
as
di e enc¸as
ce alomé icas
nas
es u u as
c anio aciais
e
na
pos u a
da
cabec¸a
en e
c ianc¸as
e
adolescen es
com
espi ac¸ão
nasal
e
espi ac¸ão
bucal
com
pad ão
de
c escimen o
acial
no mal.
Mé odo:
98
pacien es
com
idades
en e
7-16
anos
com
pad ão
de
c escimen o
acial
no mal
o am
a aliados
de
o ma
clínica
e
adiológica.
Eles
o am
classi icados
como
pacien es
com
espi ac¸ão
nasal
ou
espi ac¸ão
bucal
de
aco do
com
a
p edominância
do
modo
de
espi ac¸ão
po
meio
da
a aliac¸ão
clínica
e
his ó ica
e
da
p edominância
da
equência
espi a ó ia
con o me
quali icado
po
um
senso
de
luxo
de
a .
Os
pacien es
o am
di ididos
em
duas
aixas
e á ias
(G1:
7
a
9)
(G2:
10
a
16)
pa a
con abiliza
o
c escimen o
no mal
acial
elacionado
à
idade.
Resul ados:
As
c ianc¸as
com
espi ac¸ão
bucal
(8,0
±
0,7
anos
de
idade)
mos a am
meno
dimensão
ans e sal
naso a íngea
(MPP)
(p
=
0,030),
ao
passo
que
ou as
es u u as
o am
semelhan es
a
seus
pa es
com
espi ac¸ão
nasal
(7,6
±
0,9
anos
de
idade).
Con udo,
os
ado-
lescen es
com
espi ac¸ão
bucal
(12,3
±
2,0
anos
de
idade)
mos a am
maio
comp imen o
do
pala o
(espinha
nasal
an e io -espinha
nasal
pos e io
(ENA-ENP))
(p
=
0,049),
maio
dimensão
e ical
na
meno
ace
an e io
(Xi-ENA-Pm)
(p
=
0,015)
e
meno
posic¸ão
do
osso
hioide
a
espei o
do
plano
mandibula
(H-PM)
(p
=
0,017)
que
seus
pa es
com
espi ac¸ão
nasal
(12,5
±
1,9
anos
de
idade).
Não
o am
cons a adas
di e enc¸as
es a is icamen e
signi ica i as
na
pos u a
da
cabec¸a.
Conclusão:
Mesmo
em
indi íduos
com
pad ão
de
c escimen o
acial
no mal,
em
compa ac¸ão
a
indi íduos
com
espi ac¸ão
nasal,
as
c ianc¸as
com
espi ac¸ão
bucal
ap esen am
di e enc¸as
nas
dimensões
das
ias
aé eas.
En e
os
adolescen es,
essas
dissimila idades
incluem
es u u as
no
desen ol imen o
acial
e
na
posic¸ão
do
osso
hioide.
©
2017
Sociedade
B asilei a
de
Pedia ia.
Publicado
po
Else ie
Edi o a
L da.
Es e ´
e
um
a igo
Open
Access
sob
uma
licenc¸a
CC
BY-NC-ND
(h p://c ea i ecommons.o g/licenses/by-nc-nd/4.
0/).
In oduc ion
Physiological
b ea hing
is
o en
a ec ed
by
ana omic
o
unc ional
p oblems,
causing
he
espi a o y
cycle
o
be
ini ia ed
no
only
h ough
he
nose
bu
also
h ough
he
mou h.1,2 Compa ed
o
nasal
b ea hing
(NB)
child en,
o al
b ea hing
(OB)
child en
a e
a
highe
isk
o
es less
sleep,
diapho esis
and
enu esis
a
nigh ,
and,
in
some
cases,
e en
sleep
apnea
synd ome.
The
low-quali y
sleep
ma e ializes
as
day ime
sleepiness,
i i abili y,
and
headaches3likely
o
nega i ely
impac
academic
pe o mance.
Fu he ,
he
p es-
ence
o
hyponasal
speech
o
speech
al e a ions4inc eases
he
likelihood
o
being
classi ied
wi h
a
lea ning
disabili y.
In
ac ,
many
o
hese
child en
a e
misdiagnosed
wi h
a en-
ion
de ici
hype ac i i y
diso de
(ADHD)
and
some imes
e oneously
medica ed.5
Se e al
s udies
pos ula e
ha
OB
child en
exhibi
cha -
ac e is ics
o
he
ypical
adenoid
acies:
a
dec ease
in
he
acial
p ogna hism,
a
small
nose
and
nos ils,
a
sho
uppe
lip,
and
an
open
mou h
pos u e
which
may
be
he
sou ce
o
a
backwa d
and
downwa d
o a ion
o
he
mandible
ha
causes
an
inc ease
in
he
e ical
de elopmen
o
he
lowe
an e io
ace
and
a
na owe
an e opos e io
uppe
ai way
dimension.1,6---8 These
pa ien s’
muscle
imbalance,
owing
o
an
ana omic
econdi ion,
may
lead
o
c anio-ce ical
hype -
ex ension
and
kypho ic
pos u e.9,10 The e
a e
also
epo s
o
di e en
ypes
o
malocclusion,
such
as
open
bi es,
an e io
and/o
pos e io
c ossbi es,
class
II
malocclusion,11 con-
s ic ed
pala es,
and
gummy
smiles
esul ing
in
una ac i e
acial
ea u es.5In
addi ion,
OB
child en
o en
su e
om
ch onic
gingi i is,
pe iodon i is,
candida
in ec ions,12 den-
al
e osion,
and
ca i ies.13 Due
o
he
di icul y
o
b ea hing
and
chewing
simul aneously
o
ex ended
pe iods,
mas i-
ca o y
e iciency
dec eases.14 This,
in
u n,
leads
o
OB
child en’s
p e e ence
o
so
and
o en imes
non-nu i ious
oods
ha
inc ease
he
possibili y
o
malocclusions
and
ca i ies.
Published
e idence
is
inconclusi e,
in
pa ,
because
g ow h
pa e ns
ha e
no
been
aken
in o
accoun ,
as
ce -
ain
physical
cha ac e is ics
a e
sha ed
by
subjec s
wi h
a
p edominan
e ical
g ow h
pa e n,
who,
in
u n,
a e
mo e
likely
o
be
OB
child en.15 In
addi ion,
dec eased
adenoids
and
occlusal
ma u a ion
ha e
no
been
used
as
classi ica ion
pa ame e s
when
compa ing
ac oss
subjec s.8Mo eo e ,
di -
e en
diagnos ic
ools
ha e
been
used
o
classi y
b ea hing
modes.
The
main
objec i e
o
his
esea ch
was
o
e alua e
he
cephalome ic
di e ences
in
c anio acial
s uc u es
(i.e.,
he
o m
and
posi ion
o
he
maxilla,
mandible,
uppe
ai -
way,
and
hyoid
bone)
and
head
pos u e
be ween
NB
and
OB
child en
and
eenage s
wi h
a
no mal
acial
g ow h
pa e n,
using
a
measu able
diagnos ic
ool
o
b ea hing
mode
and
a
igo ous
selec ion
c i e ia
o
pa ien s.
I
is
hypo hesized
ha
he e
a e
ana omic
di e ences
in
c anio acial
s uc u es
in
B ea hing
mode
in luence
on
c anio acial
de elopmen
125
OB
compa ed
o
NB
child en
and
eenage s,
e en
in
pa ien s
wi h
a
no mal
acial
g ow h
pa e n.
Me hod
Pa icipan s
Pa icipan s
we e
ec ui ed
a
andom
du ing
a
ou ine
clinic
isi
a
he
College
o
In eg a ed
Child
Den is y
a
Se ille
Uni e si y.
Inclusion
c i e ia
we e
as
ollows:
whi e
boys
and
gi ls
be ween
7
and
16
yea s
o
age;
no mal
g ow h
pa e n
appea ance;
ee
o
any
neu ologic
o
congeni al
al e a ions,
gene ic
synd omes,
c anio acial
mal o ma ions,
se e e
sys emic
disease,
espi a o y
alle gies,
obs uc i e
sleep
apnea
synd ome
(OSAS),
o
as hma.
Exclusion
c i e ia:
any
uppe
ai way
su ge y,
o hodon ic
o
o hopedic
p oce-
du es,
p olonged
use
o
a
paci ie
(mo e
han
six
mon hs)
and/o
baby
bo le
(mo e
han
wo
yea s),
any
habi s
like
lip
o
inge
sucking,
o
an
e iden
an e io
ongue
posi-
ion.
O
he
187
child en
(11.3
±
0.2
yea s,
58.3%
gi ls
and
41.7%
boys)
e alua ed
o
eligibili y,
98
me
he
inclusion
c i e ia.
Fo
all
pa ien s,
one
pa en
and/o
legal
gua dian
signed
he
in o med
consen
o m.
The
s udy
and
i s
p o-
ocol
we e
app o ed
by
he
Resea ch
E hics
Commi ee
o
he
Vi gen
Maca ena-Vi gen
del
Rocio
Uni e si y
Hospi als
(Se ille,
Spain).
Measu es
No mal
acial
g ow h
pa e n
was
con i med
by
c anial
and
acial
index
and
cephalome ic
pa ame e s
(FP-MP)
(n
=
68◦±
3.5◦)
o
exclude
child en
wi h
a
g ow h
pa e n
p edisposi ion.
The
c anial
index
measu es
ans e se
and
an e opos e io
diame e s
o
he
skull
based
on
he
ollow-
ing
o mula:
maximum
ans e se
diame e
×
100/maximum
an e opos e io
diame e .
The
sco es
a e
ca ego ized
as
ollows:
dolichocephalic
(<76),
mesocephalic
(76---81),
o
b achycephalic
(>81).
The
acial
index
measu es
e ical
and
ans e se
pa ame e s
o
he
acies.
The
heigh
o
he
ace
is
de e mined
s a ing
on
he
supe cilia
plane
( he
line
uni -
ing
he
eyeb ows)
and
measu ing
e ically
o
he
gna hion
poin
(i.e.,
he
lowes
poin
o
he
so
chin).
The
wid h
o
he
ace
is
measu ed
based
on
he
bizygoma ic
wid h
as
ollows:
maximum
e ical
diame e
×
100/maximum
ans-
e se
diame e .
The
sco es
classi y
acies
as:
b achy acial
(<97),
meso acial
(97---104),
o
dolicho acial
(>104).16
B ea hing
mode
(o al
s.
nasal)
was
assessed
by
an
Ai low
Senso
o
e-Heal h
Pla o m,
designed
by
Cooking
Hacks
(Libelium®,
Libelium
Comunicaciones
Dis ibuidas
S.L,
Za agoza,
Spain).
The
senso
measu ed
he
nasal
espi a o y
equency
accu a ely
by
de ec ing
empe a u e
changes
in
he
ai low.
This
de ice
consis s
o
a
se
o
wo
p ongs
placed
in
he
nos ils
and
secu ed
by
a
lexible
h ead
ha
i s
behind
he
ea s.
B ea hing
is
measu ed
by
he
senso s
loca ed
inside
he
p ongs.
Two
measu emen s
we e
aken
a
di e en
imes
o
a oid
punc ual
subs an ial
luc ua ions
ha
could
a ec
esul s.
Pa ien s
unde wen
a
comple e
clinical
examina ion,
and
hei
clinical
his o y
and
da a
we e
collec ed
h ough
a
pa en
ques ionnai e.
Based
on
his
in o ma ion,
pa icipan s
we e
classi ied
as
ei he
OB
o
NB
pa ien s.
OB
child en
we e
de ined
by
a
lowe
nasal
espi a o y
equency
(unde
17
b ea hs
pe
minu e)
as
measu ed
by
he
s a
and
based
on
pa en al
epo s
ha
epo
p edominan
b ea hing
h ough
he
mou h,
showing
an
open
mou h
pos u e
du ing
he
day
and/o
while
sleeping
(change
om
an
up igh
o
a
supine
posi ion
may
cause
a
change
in
espi a o y
mode).1Mo eo e ,
i
he
child en
equen ly
exhibi ed
h ee
o
mo e
o
hese
symp oms,
hey
we e
included:
sno ing,
wheezing,
d ooling
on
he
pillow,
waking
up
du ing
he
nigh
gasping
o
ai ,
o
ge ing
up
i ed
in
he
mo ning.
Child en
we e
classi ied
as
nasal
b ea he s
i
hey
had
a
high
nasal
espi a o y
equency
(abo e
18
b ea hs
pe
minu e),
a
closed
mou h
du ing
he
day
and
nigh ,
and
he
p e iously
desc ibed
symp oms
we e
absen .
The
classi ica ion
was
suppo ed
by
an
o ola yngologis
by
means
o
hinomanome y.
La e al
adiog aphs
we e
aken
s anding
wi h
he
body
elaxed
and
wi h
a
na u al
head
posi ion
(sel -balance
posi ion)17 by
X- ay
equipmen
Planmeca
P omax
(Planmeca
Oy),
a
he
Facul y
o
Den is y
o
Se ille
Uni e si y.
The
cephalos a
was
placed
wi hou
adding
any
p essu e,
so
as
o
no
a ec
he
child’s
pos u e.
T adi ional
cephalo-
me ic
landma ks
we e
hand- aced
and
digi al
adiog aphs
we e
impo ed
in o
a
comme cially
a ailable
so wa e
sys-
em
(O ho
TP®,
Vime ca e
Mic oLab,
Vime ca e,
I aly)
and
analyzed
again.
The
cephalome ic
pa ame e s
we e
chosen
based
on
p e ious
publica ions6,17---19 (Figs.
1
and
2).
How-
e e ,
new
measu emen s
we e
added
o
ai way
dimensions:
•
USP:
Dis ance
o
a
poin
o
so
pala e
(5
mm
unde
o
he
uppe
poin
o
he
so
pala e)
(USP)
o
he
ho izon al
coun e poin
on
he
pos e io
pha yngeal
wall
pa allel
o
he
F ank u
ho izon al
plane
(FHP).
•
IT:
Dis ance
o
he
pos e io
and
in e io
poin
o
onsil
(T)
(5
mm
uppe
o
he
down
poin
o
he
onsil)
o
ho izon al
coun e poin
on
pos e io
pha yngeal
wall
pa allel
o
he
FHP.
•
MPP:
Dis ance
o
he
in e sec ion
poin s
on
an e io
and
pos e io
pha yngeal
wall
o
he
middle
o
he
USP
and
IT
pa allel
o
he
FHP.
•
MPp:
Dis ance
o
he
in e sec ion
poin s
on
an e io
and
pos e io
pha yngeal
wall
o
he
mandibula
plane
(MP)
pa allel
o
he
FHP.
•
C3P:
Dis ance
be ween
pos e io
pha yngeal
om
he
mos
an e io
and
in e io
poin
on
he
co pus
o
he
hi d
ce ical
e eb a
(C3)
and
an e io
pha yngeal
(P)
pa allel
o
he
FHP.
To
de ec
e o s
in
landma k
iden i ica ion
and
mea-
su emen s,
wen y
andomly
selec ed
la e al
cephalome ic
adiog aphs
we e
measu ed
and
compa ed
by
he
same
in es iga o
wo
weeks
la e .
Finally,
pa ien s
we e
di ided
in o
wo
age
g oups
(G1
=
7 --- 9
yea s)
(7.8
±
0.5
yea s)
and
(G2
=
10---16
yea s)
(12.3
±
1.0
yea s)
o
h ee
main
easons:
(1)
o
a oid
con using
b ea hing
mode
in luence
on
c anio acial
de el-
opmen
wi h
no mal
changes
in
g ow h;
(2)
o
accoun
o
he
p ocess
o
occlusal
ma u a ion----associa ed
wi h
changes
in
he
e ical
dimension
o
he
ace----based
on
he
a ia ion
in
he
e up ion
o
pe manen
ee h
o
eplace
mixed
den i-
ion;
and
(3)
o
accoun
o
he
dec ease
o
adenoids
ha
s a s
be ween
he
ages
o
7
and
10,
which
widens
he
di -
e ences
in
nasopha yngeal
dimensions.
In
child en
younge
126
Chambi-Rocha
A
e
al.
OPT-SN CTV-SN S
FC
1413
6
8
Fhp
PNS
Xi
Go
MP
Gn
1
B
Pm
FP
AANS
10
12
H
2
9
5
11
4
7
N
Figu e
1
Cephalome ic
landma ks,
angles,
and
e e ence
planes.
G ow h
pa e n:
1.
FP-MP
Angle
o med
by
acial
plane
(N-Pg)
and
mandibula
plane
(Gn-Go).
Facial
plane
is
o med
by
nasion
(N)
and
pgonion
(Pg).
Mandibula
plane
is
o med
by
gna ion
(Gn)
and
gonion
(Go);
acial
heigh :
2.
FCNA
Angle
o med
by
acial
cen e
poin
(FC)
and
line
FC-nasion
(N)
and
line
FC-subspinale
(A);
3.
Xi-ANS-Pm
Angle
o med
by
cen e
o
he
amus
poin
(Xi)
and
line
Xi-an e io
nasal
spine
(ANS)
and
Xi-sup apogonion
(Pm);
Maxilla:
4.
SNA
Angle
o med
by
skull
base
line
(SN)
and
line
N-subspinale
(A).
Skull
base
is
a
plane
om
sella
(S)
o
nasion
(N);
5.
ANS-PNS
Dis ance
om
an e io
nasal
spine
(ANS)
o
pos e io
nasal
spine
(PNS);
6.
ANS-PNS-
FhP
Angle
o med
by
pala al
plane
(ANS-PNS)
and
F ank u
plane
(FhP).
F ank u
plane
is
o med
by
o bi ale
(O )
and
ponion
(Po);
Mandible:
7.
SNB
Angle
o med
by
skull
base
line
(SN)
and
line
N-sup amen ale
(B);
8.
MP-FhP
Angle
o med
by
mandibula
plane
(MP)
and
F ank u
plane
(FhP);
9.
Go-FC
Dis-
ance
om
gonion
(Go)
o
he
acial
cen e
(FC);
10.
Xi-Pm
Dis ance
om
Xi
o
sup apogonion
(Pm);
Maxilla-Mandible:
11.
ANB
Angle
o med
by
subspinale
(A)
and
nasion
(N)
line
and
line
N-sup amen ale
(B);
Hyoid
bone:
12.
H-MP
Dis ance
om
he
mos
an e io
and
supe io
poin
o
hyoid
bone
(H)
pe pendicula
o
mandibula
plane
(MP);
C anioce ical
Pos u e:
13.
OPT-SN
Angle
o med
by
(SN)
and
odon oides
(OPT).
OPT
is
o med
by
a
line
h ough
he
pos e o-supe io
poin
and
pos e o-in e io
poin
o
odon oides;
14.
CVT-SN
Angle
o med
by
(SN)
and
ce -
ical
(CVT).
CVT
is
o med
by
a
line
h ough
he
pos e o-supe io
poin
and
pos e o-in e io
poin
o
he
ou
ce ical.
han
7
yea s
old,
adenoids
a e
s ill
physiologically
p esen
in
a
conside able
olume
in
NB
and
OB
child en;
he e o e,
i
may
di icul
o
ind
di e ences
in
he
adenoids
zone.20
S a is ical
analyses
Da a
we e
analyzed
using
desc ip i e
s a is ical
me hods.
Quan i a i e
a iables
we e
desc ibed
wi h
means
and
s anda d
de ia ions,
and
di e ences
we e
es ed
o
signi icance
wi h
S uden ’s
- es
o
independen
samples.
Di e ences
in
non-pa ame ic
a iables
we e
es ed
o
signi icance
wi h
he
Mann---Whi ney
U
es
o
independen
FhP
S
S0
2
3
MPP
PNS
IT
C3P
MPP
USP
4
5
6
7
P V-Ad
Ad1
Ad2
Ba
1
Figu e
2
Ai way
dimensions.
Nasopha ynx:
1.
Ad1-Ba
Dis-
ance
o
(ad1)
o
basion
(Ba);
Ad1
is
he
in e sec ion
poin
o
pos e io
pha yngeal
wall
and
he
line
om
pos e io
nasal
spine
(PNS)
o
basion
(Ba);
2.
ad2-S0Dis ance
o
(ad2)
o
(S0).
Ad2
is
he
in e sec ion
poin
o
pos e io
pha yngeal
wall
and
he
line
om
he
midpoin
(S0)
o
he
line
om
sella
(S)
o
basion
(Ba)
o
pos e io
nasal
spine
(PNS);
3.
P V-Ad
Dis ance
o
(P V)
poin
o
adenoid
(Ad).
P V
is
a
e ical
line
pe pendicula
o
FhP
passing
h ough
he
mos
pos e io
poin
o
he
ossa
p e igomaxila .
P V
poin
is
loca ed
5
mm
uppe
o
PNS.
O opha ynx:
4.
USP
Dis ance
o
a
poin
o
so
pala e
(5
mm
unde
o
he
uppe
poin
o
So
Pala e)
(USP)
o
he
ho izon al
coun e poin
on
he
pos e io
pha yngeal
wall
pa allel
o
F ank u
Plane
(FhP).
5.
MPP
Dis ance
o
he
in e sec ion
poin s
on
an e io
and
pos-
e io
pha yngeal
wall
o
he
middle
o
(USP)
and
(IT)
pa allel
o
FhP.
6.
IT
Dis ance
o
he
pos e io
and
in e io
poin
o
onsil
(T)
(5
mm
uppe
o
he
down
poin
o
he
onsil)
o
ho izon al
coun e poin
on
pos e io
pha yngeal
wall
pa allel
o
FhP.
7.
MPPDis ance
o
he
in e sec ion
poin s
on
an e io
and
pos e-
io
pha yngeal
wall
o
he
mandibula
plane
(MP)
pa allel
o
FhP;
Hypopha ynx:
8.
C3P
Dis ance
be ween
pos e io
pha yn-
geal
since
he
mos
an e io
and
in e io
poin
on
he
co pus
o
he
hi d
ce ical
e eb a
(C3)
and
an e io
pha yngeal.
samples.
S a is ical
signi icance
was
se
a
wo-sided
p
<
0.05.
Bon e oni
co ec ion
was
used
as
he
adjus men
me hod
o
main ain
he
p obabili y
o
ype
I
e o
below
5%
(0.05).
Acco dingly,
he
p- alue
o
conside
s a is ically
signi ican
di e ences
was
0.05/22
=
0.002.
S a is ical
es s
we e
pe o med
using
SPSS
(SPSS
o
Windows,
Ve sion
16.0.
Chicago,
USA).
Resul s
The
a e age
espi a o y
a e
was
18
b ea hs
pe
minu e;
he
lowes
espi a o y
a e
de ec ed
was
12
b ea hs
pe
B ea hing
mode
in luence
on
c anio acial
de elopmen
127
minu e
and
he
highes
a e
was
25
b ea hs
pe
minu e.
The
a e age
c anial
and
acial
index
sco es
we e
79.3
±
2.4
and
101.5
±
1.7,
espec i ely.
Means
and
s anda d
de ia ions
o
cephalome ic
a iables----c anio acial,
hyoid
posi ion,
head
pos u e
(Table
1),
and
ai way
pa ame e s
(Table
2)---- om
56
OB
pa ien s
(64.6%)
and
42
NB
pa ien s
(35.4%)
we e
compa ed
by
age
g oup.
Acco ding
o
he
la e al
cephalome ic
anal-
ysis,
in
G1
he
ai way
dis ance
in
he
egion
o
he
onsils
(MPP)
was
lowe
in
OB
(8.0
±
0.7
yea s)
han
NB
(7.6
±
0.9
yea s)
(p
=
0.03).
No
s a is ically
signi ican
di e ences
in
he
ai way
we e
ound
in
G2.
Howe e ,
in
G2,
he
lowe
an e io
acial
heigh
(Xi-ANS-Pm)
and
he
pala e
leng h
(ANS-PNS)
we e
highe
in
OB
(12.3
±
2.0
yea s)
han
in
NB
(12.5
±
1.9
yea s)
(p
=
0.015
and
p
=
0.049,
espec i ely).
Also,
he
hyoid
bone
was
loca ed
in
a
lowe
posi ion
ela i e
o
he
mandibula
plane
(H-MP)
in
OB
eenage s
han
NB
ones
(p
=
0.017).
Finally,
no
s a is ically
signi ican
di e ences
we e
ound
in
he
head
pos u e
be ween
OB
and
NB
pa ien s
in
ei he
age
g oup
(Table
2).
Discussion
P e ious
s udies
epo
ha
OB
child en
ha e
a
hype di-
e gen
acial
pa e n21---24 and
a
g ea e
lowe
an e io
acial
heigh 6,11 ha
i
was
obse ed
in
ou
esea ch
in
OB
eenage s
(G2)
wi h
a
no mal
acial
pa e n
bu
no
in
G1.
A
g ea e
inclina ion
o
he
mandible
plane22,23 was
obse ed
which,
oge he
wi h
a
pos e io
o a ion
o
pala al
plane,25 migh
indica e
he
e ical
di ec ion
o
mandibu-
la
g ow h11,26 and
he
de elopmen
o
a
class
II
skele al
malocclusion.11 Howe e ,
he
OB
pa ien s
(63.9%)
p esen ed
class
I
skele al
occlusion.
Acco ding
o
p e ious
indings,
OB
pa ien s’
maxilla
and
mandible
we e
mo e
e uded
in
ela ion
o
hei
skull
base.23 Ne e heless,
Uca
e
al.25
obse ed
ha
only
he
maxilla
was
mo e
e ogna hic,
whe eas
o he s
ound
ha
only
he
mandible
was
mo e
e uded.26
The
p esen
esul s
show
a
low
posi ion
o
he
hyoid
bone
ela i e
o
he
mandibula
plane
in
OB
in
G2,
which
suppo s
p e ious
indings
by
Cuccia
e
al.27
Nasopha yngeal
sec ional
dimensions
inc ease
wi h
he
es
o
body
issues
du ing
he
g ow h
pe iod,
bu
he
ade-
noid
issue
s a s
o
diminish
be ween
he
ages
o
7
and
10,
only
o
disappea
du ing
adul hood.
The
measu emen s
o
he
uppe
ai way
space
we e
smalle
in
OB
han
in
NB
child en
(G1)
in
he
egion
o
he
onsils
(MPP)
bu
no
in
G2,
suppo ing
p e ious
wo k.26 The e o e,
onsils
a e
mo e
hype ophic
in
child en
han
eenage s.
This
esul
could
be
a ec ed
by
he
possibili y
ha
G1
pa ien s’
adenoids
we e
s ill
a
he
onse
o
hei
educ ion,
whe eas
G2
pa ien s’
adenoids
we e
al eady
sh unken.
In
addi ion,
he
new
ai -
way
measu emen s
in
his
s udy
could
a ec
he
abili y
o
compa e,
because
hey
we e
pa allel
o
he
F ank u
plane
(a
cons an
plane)
o
a oid
inco ec
compa a i e
esul s
based
on
a
a iable
plane.
Se e al
s udies
epo
OB
pa ien s
wi h
c anio-ce ical
hype ex ension,27 whe eby
pos u al
p oblems
a e
signi i-
can ly
mo e
common
among
hese
child en.9The
p esen
esea ch
showed
a
ce ical
spine
pos u al
change
in
90.3%
o
OB
bu ,
as
bo h
g oups
p esen ed
high
pe cen ages
o
c anio acial
hype ex ension,
di e ences
we e
no
s a is i-
cally
signi ican .
I
is
specula ed
ha
he
in ense
use
o
new
echnological
de ices
by
he
young,
such
as
cell
phones
and
able s,
migh
con ibu e
his
lack
o
subs an ial
di e ences
in
c anio acial
hype ex ension.
A
p e ious
s udy
ound
myo unc ional
and
c anio acial
al e a ions
among
OB
child en
be ween
he
ages
o
7---10,23
whe eas
he
p esen
s udy
ound
hese
al e a ions
in
OB
child en
wi h
a
mean
age
o
12.3
±
2.0
(G2).
The
disc ep-
ancy
may
esul
om
hese
s udies
ailing
o
ake
he
g ow h
pa e ns
in o
accoun .
In
he
p esen
s udy,
pa ien s
wi h
an
abno mal
g ow h
pa e n
we e
excluded
based
on
he
c anial
and
acial
index
and
cephalome ic
pa ame-
e s,
because
pa ien s
wi h
a
e ical
g ow h
pa e n
ha e
common
skele al
ea u es,
i.e.,
na owe
an e opos e io
dimension
o
he
ai way,
e usion
o
he
maxilla
and
he
mandible,
e ical
maxilla y
excess,
and
a
highe
class
II
skele al
disc epancy.19,28 These
pa ien s’
cha ac e is ics
migh
be
a
compensa o y
mechanism
ha
could
igge
he
ansi ion
om
NB
o
OB.
Con e sely,
ho izon al
g ow h
pa -
e n
is
usually
cha ac e ized
by
a
mo e
an e io
mandible.
This
esul s
in
a
wide
lowe
pha yngeal
ai way,
which
a o s
nasal
b ea hing.
The e o e,
g ow h
pa e ns
could
a ec
o
bene i
physiological
espi a o y
unc ion.29
I
is
impo an
o
be
able
o
de ec
pa ien s
wi h
an
OB
p edomina ion.
Ea ly
e e al
o
he
co ec ion
o
his
pa hological
unc ion
is
key
o
he
p e en ion
o
i egula i-
ies
in
c anio acial
de elopmen
and
o hodon ic
p oblems.
By
elimina ing
he
g ow h
pa e n
con ounding
in
his
s udy
and
compa ing
pa ien s
acco ding
o
hei
g ow h
s age,
i
was
possible
o
de ec
i
eal
di e ences
exis
be ween
NB
and
OB
child en
(G1)
and
eenage s
(G2).
This
s udy
has
ce ain
limi a ions.
Fi s ,
in
a
c oss-
sec ional
s udy,
associa ions
do
no
imply
causal
ela ion-
ships.
In
ac ,
Shanke
e
al.28 ound
ha
se e al
child en
swi ched
be ween
o al
and
nasal
espi a o y
mode
du ing
he
ou
yea s
o
hei
in es iga ion.
Howe e ,
as
wi h
any
ea able
o
p e en able
condi ion,
he
possibili y
o
an
obse a ional
longi udinal
s udy
wi hou
in e ening
once
OB
is
de ec ed
is
p ecluded
o
e hical
easons.
Second,
he
small
sample
size
esul ing
om
he
s ic
selec ion
c i e ia
may
ha e
limi ed
he
powe
o
he
analyses
o
de ec
u -
he
di e ences.
Thi d,
because
his
s udy
did
no
ec ui
NB
as
OB
pa icipan s,
he
powe
o
he
analyses
may
ha e
su e ed
om
his
subs an ial
di e ence
in
he
sizes
o
he
subg oups
being
compa ed.
Despi e
hese
limi a ions,
hese
indings
may
help
medical
p o essionals
be e
man-
age
pa ien s
wi h
b ea hing
dis u bances,
knowing
ha
his
migh
indica e
a
de elopmen al
imbalance.
The
s udy
also
has
i s
s eng hs.
The
highly
p ecise
selec-
ion
c i e ia,
by
including
only
pa ien s
wi h
no mal
g ow h
pa e n,
educed
he
po en ial
bias
o
including
child en
wi h
a
gene ic
p edisposi ion
o
OB.
In
addi ion,
occlusal
ma u a ion
and
he
physiological
dec ease
o
he
adenoids
we e
aken
in o
accoun
when
compa ing
he
esul s.
Finally,
a
senso
ha
supplied
measu able
da a
o
be e
classi y
pa ien s’
mode
o
b ea hing
was
u ilized.
To
he
bes
o
he
au ho s’
knowledge,
his
measu emen
de ice
had
ne e
been
used
in
his
con ex .
This
combined
wi h
he
ac
ha
a
cons an
plane
was
used
as
e e ence
o
he
ai way
mea-
su emen s,
may
p o e
hese
da a
o
be
mo e
accu a e
han
hose
o
much
o
p e ious
esea ch.

128
Chambi-Rocha
A
e
al.
Table
1
C anio acial,
hyoid
posi ion,
and
head
pos u e
pa ame e s
in
nasal
and
o al
b ea hing
child en
and
eenage s.
G oup
I
G oup
II
NB
OB
p-Value
NB
OB
p-Value
G ow h
pa e n
1.
FP-MP
66.813◦±
1.13
67.028◦±
3.38
0.864a67.056◦±
1.91
67.000
±
2.71◦0.958a
Facial
heigh
2.
FCNA
58.438◦±
1.87
57.639◦±
4.48
0.635a57.833◦±
2.76
59.962◦±
3.05
0.111a
3.
Xi-ANS-Pm
44.250◦±
3.47
43.917◦±
3.93
0.838a42.278◦±
3.30
46.346◦±
3.69
0.015a
Maxilla
4.
SNA
79.438◦±
3.38
81.750◦±
4.57
0.214a78.944◦±
2.57
77.115◦±
4.63
0.298a
5.
ANS-PNS-FHP
−1.750◦±
3.13
−1.056◦±
3.85
0.659a0.56◦±
3.98
−2.000◦±
2.82
0.171a
6.
ANS-PNS
44.125
±
3.90
mm
44.667
±
3.59
mm
0.733a46.222
±
2.63
mm
49.269
±
3.75
mm
0.049a
Mandible
7.
SNB
77.500◦±
4.50
77.353◦±
3.81
0.892a77.688◦±
2.65
74.250◦±
3.18
0.082b
8.
MP-FHP
26.563◦±
2.61
26.000◦±
5.54
0.788a28.000◦±
4.19
28.192◦±
3.73
0.911a
9.
Go-FC
51.000
±
4.62
mm
50.528
±
4.11
mm
0.797a57.167
±
3.26
mm
58.077
mm
±
6.57
mm
0.706a
10.
Xi-Pm
58.875
mm
±
4.12
mm
56.722
mm
±
1.97
mm
0.81a63.833
mm
±
3.29
mm
63.769
mm
±
6.59
mm
0.979a
Maxilla-mandible
11.
ANB
2.063◦±
2.88
4.250◦±
2.49
0.60a1.833◦±
1.67
2.192◦±
3.12
0.757a
Hyoid
bone
12.
H-MP
9.500
mm
±
1.61
7.765
±
3.73
mm
0.683b8.563
±
3.58
mm
12.100
mm
±
6.06
mm
0.017b
C anioce ical
pos u e
13.
OPT-SN
83.813◦±
9.94
83.361◦±
12.15
0.928a79.944◦±
9.26
85.808◦±
9.72
0.172a
14.
CVT-SN
105.875◦±
7.94
106.194◦±
10.75
0.941a101.444◦±
7.48
108.115◦±
10.22
0.11a
Bold
alues
ep esen
he
s a is ically
signi ican
di e ence.
NB,
nasal
b ea hing;
OB,
o al
b ea hing.
aS uden ’s
- es .
bMann---Whi ney
U- es .
B ea hing
mode
in luence
on
c anio acial
de elopmen
129
Table
2
Ai way
pa ame e s
in
nasal
and
o al
b ea hing
child en
and
eenage s.
G oup
I
G oup
II
NB
OB
p-Value NB
OB
p-Value
Ai way
Nasopha ynx
1.
ad1-Ba
23.833
±
5.57
mm
21.529
±
7.07
mm
0.261b21.611
±
3.87
mm
22.192
±
5.54
mm
0.789a
2.
ad2-S0
22.750
±
3.17
mm
21.417
±
3.41
mm
0.358a21.625
±
4.07
mm
20.800
±
6.28
mm
0.647b
3.
P V-Ad
11.500
±
3.76
mm
10.000
±
3.69
mm
0.724b14.556
±
6.00
mm
13.692
±
4.99
mm
0.717a
O opha ynx
4.
USP 12.688
±
2.01
mm 11.333
±
2.72
mm
0.221a14.222
±
3.98
mm
12.577
±
3.38
mm
0.309a
5.
MPP 11.000
±
2.46
mm 8.765
±
2.15
mm 0.030b10.000
±
2.34
mm 9.346
±
2.60
mm
0.554a
6.
IT 10.063
±
2.51
mm 10.472
±
1.89
mm 0.650a10.167
±
4.13
mm 11.077
±
2.72
mm 0.539a
7.
MPp10.500
±
2.34
mm 9.972
±
2.69
mm 0.637a9.056
±
2.81
mm 10.731
±
3.94
mm 0.287a
Hypopha ynx
8.
C3P
9.938
±
2.77
mm
9.86
±
3.63
mm
0.958a8.444
±
3.14
mm
10.692
±
3.82
mm
0.162a
Bold
alue
ep esen s
he
s a is ically
signi ican
di e ence.
NB,
nasal
b ea hing;
OB,
o al
b ea hing.
aS uden ’s
- es .
bMann---Whi ney
U
es .
A e
examining
child en
and
eenage s
wi h
a
no -
mal
g ow h
pa e n,
his
s udy
shows
ha
he e
a e
cephalome ic
di e ences
be ween
indi iduals
wi h
o al
b ea hing
and
nasal
b ea hing
modes.
Compa ed
o
nasal
b ea he s,
a
lowe
an e opos e io
dimension
o
he
ai way
in
o al
b ea hing
child en
is
ound;
whe eas
in
eenage
o al
b ea he s,
he e
is
a
g ea e
lowe
an e io
acial
heigh ,
a
longe
pala e,
and
a
lowe
posi ion
o
he
hyoid
bone
ela i e
o
he
mandibula
plane.
These
indings
a e
o
p ac ical
in e es
o
clinicians
when
diagnosing,
ea ing,
and/o
e e ing
pa ien s
o
specialis s
o
b ea hing
dis u bances- ela ed
issues.
As
hese
issues
migh
indica e
a
de elopmen
imbalance,
ea ly
diagnosis
is
impo an
o
co ec
o
amelio a e
any
nega i e
e ec s
wi h
imely
ea men .
Fu u e
esea ch
examining
la ge
samples
o
pa ien s
wi h
same
selec ion
c i e ia
as
used
he e
is
needed
in
o de
o
examine
hei
c anio acial
de elopmen
acco ding
o
mode
o
b ea hing,
while
aking
in o
accoun
g ow h
pa -
e n,
age,
and
gende .
Such
a
s udy
may
p o ide
u he
e idence
o
he
subs an ial
in luence
o
b ea hing
in
c a-
nio acial
de elopmen
and
head
pos u e.
Con lic s
o
in e es
The
au ho s
decla e
no
con lic s
o
in e es .
Acknowledgmen s
The
au ho s
hank
Hosanna
Sole -Vilá,
Ph.D.
o
he
emu-
ne a ed
medical
edi ing
se ices.
Mo eo e ,
hey
hank
Angelo
Vanella,
adiologis ,
o
he
O ho
TP
so wa e
con i-
gu a ion.
Re e ences
1.
Salem
OH,
B iss
BS,
Annino
DJ.
Naso espi a o y
unc ion
and
c anio acial
mo phology
---
a
e iew
o
he
su gical
managemen
o
he
uppe
ai way.
Semin
O hod.
2004;10:54---62.
2.
Fa id
MM,
Me walli
N.
Compu ed
omog aphic
e alua ion
o
mou h
b ea he s
among
paedia ic
pa ien s.
Den omaxillo ac
Radiol.
2010;39:1---10.
3.
Ab eu
RR,
Rocha
RL,
Lamounie
JA,
Gue a
AF.
E iology,
clini-
cal
mani es a ions
and
concu en
indings
in
mou h-b ea hing
child en.
J
Pedia
(Rio
J).
2008;84:529---35.
4.
Hi os
SF,
A akaki
R,
Solé
D,
Weckx
LL.
O al
b ea hing
and
speech
diso de s
in
child en.
J
Pedia
(Rio
J).
2013;89:361---5.
5.
Je e son
Y.
Mou h
b ea hing:
ad e se
e ec s
on
acial
g ow h,
heal h,
academics,
and
beha io .
Gen
Den .
2010;58:79---80,
18---25;
quiz
26-7.
6.
Souki
BQ,
Lopes
PB,
Pe ei a
TB,
F anco
LP,
Becke
HM,
Oli ei a
DD.
Mou h
b ea hing
child en
and
cephalome ic
pa e n:
does
he
s age
o
den al
de elopmen
ma e ?
In
J
Pedia
O o hi-
nola yngol.
2012;76:837---41.
7.
Pel omaki
T.
The
e ec
o
mode
o
b ea hing
on
c anio acial
g ow h
--- e isi ed.
Eu
J
O hod.
2007;29:426---9.
8.
P es on
CB,
Tobias
PV,
Salem
OH.
Skele al
age
and
g ow h
o
he
nasopha ynx
in
he
sagi al
plane:
a
cephalome ic
s udy.
Semin
O hod.
2004;10:16---38.
9.
Milanesi
JM,
Bo in
G,
Co êa
EC,
da
Sil a
AM,
Bo oluzzi
DC,
Souza
JA.
Impac
o
he
mou h
b ea hing
occu ed
du ing
child-
hood
in
he
adul
age:
biopho og amme ic
pos u al
analysis.
In
J
Pedia
O o hinola yngol.
2011;75:999---1004.
10.
Con i
PB,
Sakano
E,
Ribei o
MA,
Schi inski
CI,
Ribei o
JD.
Assess-
men
o
he
body
pos u e
o
mou h-b ea hing
child en
and
adolescen s.
J
Pedia
(Rio
J).
2011;87:357---63.
11.
Ha a i
D,
Redlich
M,
Mi i
S,
Hamud
T,
G oss
M.
The
e ec
o
mou h
b ea hing
e sus
nasal
b ea hing
on
den o acial
and
c a-
nio acial
de elopmen
in
o hodon ic
pa ien s.
La yngoscope.
2010;120:2089---93.
12.
Gula i
MS,
G ewal
N,
Kau
A.
A
compa a i e
s udy
o
e ec s
o
mou h
b ea hing
and
no mal
b ea hing
on
gingi al
heal h
in
child en.
J
Indian
Soc
Pedod
P e
Den .
1998;16:72---83.
13.
Choi
JE,
Waddell
JN,
Lyons
KM,
Kiese
JA.
In ao al
pH
and
em-
pe a u e
du ing
sleep
wi h
and
wi hou
mou h
b ea hing.
J
O al
Rehabil.
2016;43:356---63.
14.
Nagaiwa
M,
Gunjigake
K,
Yamaguchi
K.
The
e ec
o
mou h
b ea hing
on
chewing
e iciency.
Angle
O hod.
2016;86:227---34.
15.
Joseph
AA,
Elbaum
J,
Cisne os
GJ,
Eisig
SB.
A
cephalome ic
compa a i e
s udy
o
he
so
issue
ai way
dimensions
in
pe -
sons
wi h
hype di e gen
and
no modi e gen
acial
pa e ns.
J
O al
Maxillo ac
Su g.
1998;56:135---40.
130
Chambi-Rocha
A
e
al.
16.
Canu
B usola
JA.
Análisis
mo ológico
acial.
In:
Canu
B u-
sola
JA,
o g.
O odoncia
clínica
y
e apeú ica.
2
ed.
Ba celona:
Else ie
Espa˜
na;
2005.
17.
Sp inga e
SD.
A
e-in es iga ion
o
he
ela ionship
be ween
head
pos u e
and
c anio acial
g ow h.
Eu
J
O hod.
2012;34:397---409.
18.
Dubojska
AM,
Smiech-Slomkowska
G.
Na u al
head
posi ion
and
g ow h
o
he
acial
pa
o
he
skull.
C anio.
2013;31:109---17.
19.
Fe es
MF,
Enoki
C,
Anselmo-Lima
WT,
Nakane
Ma sumo o
MA.
Nasopha yngeal
and
acial
dimensions
o
di e en
mo phologi-
cal
pa e ns.
Den al
P ess
J
O hod.
2010;15:52---61.
20.
Vilella
BD,
Vilella
OD,
Koch
HA.
G ow h
o
he
nasopha ynx
and
adenoidal
de elopmen
in
B azilian
subjec s.
B az
O al
Res.
2006;20:70---5.
21.
F anco
LP,
Souki
BQ,
Pe ei a
TB,
Meyge
de
B i o
G,
Gonc¸al es
Becke
HM,
Pin o
JA.
Is
he
g ow h
pa e n
in
mou h
b ea he s
compa able
wi h
he
coun e clockwise
mandibula
o a ion
o
nasal
b ea he s?
Am
J
O hod
Den o ac
O hop.
2013;144:341---8.
22.
Malho a
S,
Pandey
RK,
Naga
A,
Aga wal
SP,
Gup a
VK.
The
e ec
o
mou h
b ea hing
on
den o acial
mo phology
o
g owing
child.
J
Indian
Soc
Pedod
P e
Den .
2012;30:27---31.
23.
Pe ei a
FC,
Mo onaga
SM,
Fa ia
PM,
Ma sumo o
MA,
T awi zki
LY,
Lima
SA,
e
al.
Myo unc ional
and
cephalome ic
e alua-
ion
o
mou h
b ea he s.
Re
B as
O o inola ingol.
2001;67:
43---9.
24.
Rossi
RC,
Rossi
NJ,
Rossi
NJ,
Yamashi a
HK,
Pigna a i
SS.
Den o-
acial
cha ac e is ics
o
o al
b ea he s
in
di e en
ages:
a
e ospec i e
case---con ol
s udy.
P og
O hod.
2015;16:92.
25.
Uca
FI,
Ekize
A,
Uysal
T.
Compa ison
o
c anio acial
mo -
phology,
head
pos u e
and
hyoid
bone
posi ion
wi h
di e en
b ea hing
pa e ns.
Saudi
Den
J.
2012;24:135---41.
26.
Chung
Lengh
Mu˜
noz
I,
Bel i
O a
P.
Compa ison
o
cephalome -
ic
pa e ns
in
mou h
b ea hing
and
nose
b ea hing
child en.
In
J
Pedia
O o hinola yngol.
2014;78:1167---72.
27.
Cuccia
AM,
Lo i
M,
Ca adonna
D.
O al
b ea hing
and
head
pos-
u e.
Angle
O hod.
2008;78:77---82.
28.
Shanke
S,
Fields
HW,
Beck
F,
Vig
P,
Vig
KW.
A
longi udinal
assess-
men
o
uppe
espi a o y
unc ion
and
den o acial
mo phology
in
8-
o
12-yea -old
child en.
Semin
O hod.
2004;10:45---53.
29.
Bolzan
GD,
Souza
JA,
Bo on
LD,
Sil a
AM,
Co êa
EC.
Facial
ype
and
head
pos u e
o
nasal
and
mou h-b ea hing
child en.
J
Soc
B as
Fonoaudiol.
2011;23:315---20.